MedicaidPrior AuthMedium impact
MAB2025110701
Pennsylvania Medicaid (DHS)·PA · Cardiology, Family Medicine, Internal Medicine +1 more·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization requirements for Calcium Channel Blockers, adding new criteria for combination products with multiple active ingredients. Non-preferred Calcium Channel Blockers and those exceeding quantity limits will require prior authorization with specific medical necessity documentation.
Action Required
By January 5, 2026: Update prior authorization workflows for Pennsylvania Medicaid patients prescribed Calcium Channel Blockers. Train billing team and providers on new criteria requiring documentation of clinical reasons why individual active ingredients cannot be used concurrently for combination products. Update encounter forms to prompt providers for therapeutic failure history, contraindications, or intolerances to preferred medications. Verify preferred drug list at papdl.com before prescribing. Claims without proper prior authorization will be denied.